| NPI | 1912599309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-141931) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-141931) |
| Enumeration Date | 2021-02-07 |
| Last Update Date | 2022-09-27 |